• Maketwohomevisitstopregnantwomenandthreehomevisitstonewlydeliveredmothersinthefirstweekafterbirth topromoteandsupporteffectivematernalandnewborncare
• Identifymothersornewborndangersignsandreferusinga referral formand/orescort themotherorcaregiver
• Conducttwomorevisitsforlowbirthweightbabiesto promote care including skin to skin/kangaroomothercare
WHAT LESSONS HAVE SO FAR BEEN LEARNT?• Conducting trainings closer to home in the
communityisfeasibleandpreferredbyCHWs• Manystakeholdersneed tobesensitizedprior to
programintroduction• Demand side issues (Quality of facility care)
predominateCHWwork• Training CHWs with health workers good for
referrals,linkagesandsubsequentsupervisions• CHWs need to be commissioned immediately
after training and provided with all logistics andmotivation
• Registeringwomenofchildbearingageisimportantforidentificationofearlypregnancy
WHAT CAN UNEST CONTRIBUTE AT THIS STAGE TOWARDS SCALE UP OF NEWBORN CARE?
• Expertise–wehaveapoolofexperiencednationalanddistricttrainersforCHWs
• Materials–wehaveimprovedandtestedmanualsforCHWstrainingandsupervision
• Advocacy video documentary – Togetherwith stakeholders, UNEST developed a videodocumentary which highlights newborn care inUgandawithpolicyandimplementationchallengesandopportunities
Integrating Community Health Workers in Maternal/Newborn Programming in Uganda
UGANDA NEWBORN SURVIVAL STUDY (UNEST)
FOR FURTHER INFORMATION, CONTACTGeorge Pariyo, The Principal Investigator, UNEST and Assoc. Prof, Makerere University School of Public Health
Email:[email protected], Tel. 00256414530291Dr. Peter Waiswa, Co-PI and Study Coordinator, UNEST
Email:[email protected] / [email protected]. 00256772405357
WHAT HEALTH FACILITY STRENGTHENING IS DONE?Health facility strengthening is evolving as we learnwhattodo.Sofarwehavedonethefollowingthroughthedistrictsystem:
• Qualityofcare formaternalandnewborncare inhealthfacilitiesthroughjointproblemidentificationandplanning,traininginbasicandemergencecareincluding newborn resuscitation and care of thesicknewborn.
• Training is through a 5 day course focusing onmaternal,newborncareandaudit (bothmaternaland perinatal). The course is skills based andaddresses the leading killers of mothers andnewbornbabies.
• Support to health facilities in form of basicequipment,drugsandsupplies
What is UNEST?
2. Health facility strengthening aimed at improvingqualityofcareformothersandnewbornbabies
3. Improved linkage between the community andhealthfacilities
EXPECTED POLICY RELEVANT OUTPUTSWehopethatbytheendofthisstudy,wewillhavethefollowingkeyoutputs:• ProgramreadyTrainingandBCCpackagefor
CHWsinmaternalandnewbornhealth
• Costbenefitanalysisofcommunityhealthworkerpackage
• Apackageofhowtostrengthenpublichealthfacilitiesandtheeffectofthisonmaternalandnewbornoutcomes(Healthfacilitystrengtheningcomponent).
• Adocumentationofcontextinwhichtheinterventionworksordoesn’twork
• Peerreviewedpublicationsandotherinformationleaflets
COMMUNITY HEALTH WORKERS SELECTION, TRAINING, SUPPORT AND SUPERVISION• Selection - Selection based on the Uganda
villagehealthteam(VHT)approach–Districtled,community participation, volunteers, resident insaidvillage,someliteracy,andgenderequality
• Training - Non-residential close to home, skillsbasedtrainingwithparticipationofhealthworkersfrom the nearby villages. Focus is on key familycare practices, problem solving, communitymobilization,referral,andmanagementofrecordsandsupplies.
• Supervision – Handed to local leaders andhealth workers. Technical supervision monthlyalongdistricthealthsystemstructuresbyspecially
trained health workers for CHW supervision. Inaddition,regularmeetingsofCHWsareorganizedwithhealthworkers.A“super”CHWateachparishlinksCHWsandhealthworkers.
• Support and motivation– Graduate with acertificate,facilitatedwithabasicpackageincludingademonstrationmamakit,BCCmaterials,andasmalltransportrefundduringmonthlymeetings.
WHAT IS THE AIM OF UNEST?Makerere University School of Public Health withsupportfromtheSavingNewbornLivesProjectofSavethe Children (USA), through a grant from Bill GatesFoundationisconductingaclusterrandomisedstudyinthe Iganga/MayugeHealthDemographicSurveillanceSite (HDSS) in Iganga and Mayuge Districts. Theaim of UNEST is to develop and cost an integratedmaternal-newborncarepackagethatlinkscommunityandfacilitycareandevaluateitseffectonmaternalandneonataloutcomesinordertoinformpolicyandscaleupinUganda
THE RATIONALE OF UNEST• Many Sub-Saharan Africa countries including
Uganda are off track to achieve the MillenniumDevelopment Goal four (Child survival), mainlybecauseneonatalmortalityhasnotreduced.
• Globally, an estimated 4 million babies eachyear, 98% in developing countries. In Uganda,anestimated45,000neonataldeathsand45,100stillbirthsoccurperyearofwhich15-32%(31,800)couldbesavedbysimple interventionsproventowork(LawnJE,KerberK,eds.,2006).
• TheNationalHealthSectorStrategicPlanprioritisesnewbornhealth,initiallytocomplimentcurrentcarewithcommunityinterventions.Ouraimistoprovidealearningexperienceforoperationalisingthepolicyintonationalprogrammingandscaleup.
WHAT ARE THE KEY UNEST COMPONENTS?Theseareevidencebasedandwereagreedonafteraconsultativeprocesswithpolicymakers, expertsandimplementers,andinclude:1. Community based intervention by community
healthworkerstrainedtomake2pregnancyand3postnatalvisitsinthefirstweekafterbirth.
Community sensitization and CHW selection
Training of CHWs: commissioning
ROLES OF A COMMUNITY HEALTH WORKER • Each CHW is responsible for about 100—150
householdsandregistersallwomeninchildbearingage,pregnantandnewlydeliveredmothers